ASTRO Town Hall Discussion (Poll % on site)

[TheWallnerus]

Perhaps?

The way this is being framed is that this is some kind of change, as in, we will be moving into a world where Virtual Direct/General is "the norm". As in, the "threat" is in the future.

I see it as the change happened on January 1st, 2020, and then again in March/April 2020.

The consequences on any industry/workforce began many years ago. This is our status quo.

There were three options for ASTRO, really:

1) Do nothing
2) Acknowledge our legislative reality and craft a future-facing strategy for the field
3) Acknowledge our legislative reality and attempt to turn back the clock (uniquely, as it turns out)

Of the 3, the one they chose is the worst. Now we have to spend time and energy on this instead of something even mildly productive.

ASTRO struggled mightily and loudly against the Jan 2020 change (permanent general in hospital) and Jan 2021 change (NPs could supervise IGRT in hospitals). (ASTRO supported virtual supervision in all sites of service in light of COVID.)

Now, it is attempting to struggle again, years later, in light of perhaps supervision changing “again” in 2025. If we think about it, this re-protestation is likely to have the same success rate as curative attempt reirradiation. Except with this tumor, many other doctors are vigorously trying to keep the recurrent tumor from being touched much less retreated.

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[elementaryschooleconomics]

Stuff like this is what I'm talking about:

There's only ONE WAY this can happen. And that's if your institution is an unstoppable juggernaut, a cross between a mob boss and the Terminator.

And just to be even more confusing/nuanced: I actually think Penn/CHOP do great medicine! I'd go there! I'd send my family there!

But does Penn, or its peers, care AT ALL about this in terms of the levers and loopholes they will exploit to maximize profit?

No.

Will the behavior of Penn, Anderson, Mayo, Sloan - will it have an effect on our workforce?

Yes.

Supervision is the WRONG BATTLE.

 

[drowsy12]

f we think about it, this re-protestation is likely to have the same success rate as curative attempt reirradiation.

interesting analogy. so it will work sometimes. you just gave them the green flag of support of their attempts haha.

 

[drowsy12]

Stuff like this is what I'm talking about:

View attachment 385332

There's only ONE WAY this can happen. And that's if your institution is an unstoppable juggernaut, a cross between a mob boss and the Terminator.

And just to be even more confusing/nuanced: I actually think Penn/CHOP do great medicine! I'd go there! I'd send my family there!

But does Penn, or its peers, care AT ALL about this in terms of the levers and loopholes they will exploit to maximize profit?

No.

Will the behavior of Penn, Anderson, Mayo, Sloan - will it have an effect on our workforce?

Yes.

Supervision is the WRONG BATTLE.

I am confused by the constant muddying of the waters. You're bringing up wildly different things. Some of which are in ASTRO's purview and some of which are not.

ASTRO can give their opinion on supervision. It has the direct potential, as you admit, to really hurt the livelihood of current members. big time. Maybe you are right that it will have zero impact on CMS' view. I tend to agree.

But if you think CMS doesn't care about ASTRO's opinion, then I will tell you who REALLY doesn't give a damn. that's the corporate medical complex in the USA.

'Will the behavior of Penn, Anderson, Mayo, Sloan - will it have an effect on our workforce?'

Yeah - pretty clearly they are leading to more jobs and more dollars going to rad onc departments overall. For better or worse.

The discussion of the overall societal impact rising costs of medicine is a totally different topic, and I don't think any of us want to go too far down this rabbit hole.

 

[CurbYourExpectations]

I don't understand the points people are trying to make here.

What should ASTRO be doing? If they can't support supervision (which is beneficial to the large majority of us), what could they possibly support that people will listen to that will help the majority of RadOncs?

And why are there people here hoping for the worst possible outcome that will completely destroy the field?

 

[drowsy12]

I don't understand the points people are trying to make here.

What should ASTRO be doing? If they can't support supervision (which is beneficial to the large majority of us), what could they possibly support that people will listen to that will help the majority of RadOncs?

And why are there people here hoping for the worst possible outcome that will completely destroy the field?

yep.

I really find it very confusing.

 

[elementaryschooleconomics]

Stuff like this is what I'm talking about:

View attachment 385332

There's only ONE WAY this can happen. And that's if your institution is an unstoppable juggernaut, a cross between a mob boss and the Terminator.

And just to be even more confusing/nuanced: I actually think Penn/CHOP do great medicine! I'd go there! I'd send my family there!

But does Penn, or its peers, care AT ALL about this in terms of the levers and loopholes they will exploit to maximize profit?

No.

Will the behavior of Penn, Anderson, Mayo, Sloan - will it have an effect on our workforce?

Yes.

Supervision is the WRONG BATTLE.

Further, from a story that broke yesterday:

For those that don't know, Mayo offers the "MCCN":

They have, for years, offered this:

I'm sure we've all seen the rise in eConsults, independent of this.

The discussion of the overall societal impact rising costs of medicine is a totally different topic, and I don't think any of us want to go too far down this rabbit hole.

You're kidding, right?

You HAVE TO GO DOWN THIS RABBIT HOLE. This is all related.

I understand the easy logic here about "Direct Supervision means a RadOnc has to physically be present means more jobs".

That's not real. That's an illusion.

Do I think there's a chance that, if Virtual Direct is made permanent in 2025, there could be a handful of fewer jobs available in 2025-2030?

Maybe. I genuinely don't know.

But to see drastic changes to our workforce in a rapid timeline, one of two things need to happen:

1) Staffing of existing linacs needs to change.
2) New linacs need to be built.

#2 is basically off the table. Outside of Florida (lol), the CoN process is a huge roadblock to linac expansion.

Further, the capital-rich days of the last few years is gone. Interest rates are high. Purse strings are tight. Reimbursement is down. You're not going to see a flood of new linacs because...well that's not something that has ever happened, really.

For #1: Hospitals HATE CHANGE. There are a lot of downstream effects to a place that is used to having an on-site RadOnc for 30 years just...not having an onsite RadOnc anymore.

@drowsy12 - what do you mean "rise of Bridge"??? Does Bridge even have a clinical site yet? Maybe one is what I've heard? The probability they fail is quite high regardless of regulation.

I don't understand the points people are trying to make here.

What should ASTRO be doing? If they can't support supervision (which is beneficial to the large majority of us), what could they possibly support that people will listen to that will help the majority of RadOncs?

And why are there people here hoping for the worst possible outcome that will completely destroy the field?

Relentless.

Unstoppable.

Advocacy.

Blanket all media with pro-radiotherapy ads. Stories in print and digital. Television. Blogs. Podcasts.

Hire effective lobbyists.

ACRO already has one. Liberty Partners are beasts. Look what they did for 21C.

ROCR and Supervision are tilting windmills. The playbook already exists.

Lobby. PR. Lobby. PR. Lobby. PR.

 

[drowsy12]

@drowsy12 - what do you mean "rise of Bridge"??? Does Bridge even have a clinical site yet? Maybe one is what I've heard? The probability they fail is quite high regardless of regulation.

I meant only their emergence/existence. Otherwise I questioned you - what is the abuse that exists now, I was replying to your post

 

[TheWallnerus]

I am confused by the constant muddying of the waters. You're bringing up wildly different things. Some of which are in ASTRO's purview and some of which are not.

I don't understand the points people are trying to make here.

What should ASTRO be doing? If they can't support supervision (which is beneficial to the large majority of us), what could they possibly support that people will listen to that will help the majority of RadOncs?

And why are there people here hoping for the worst possible outcome that will completely destroy the field?

Relentless.

Unstoppable.

Advocacy.

Blanket all media with pro-radiotherapy ads. Stories in print and digital. Television. Blogs. Podcasts.

Hire effective lobbyists.

God, grant me the serenity to accept the things I cannot change
The courage to change the things I can
And the wisdom to know the difference

 

[drowsy12]

I don't understand the points people are trying to make here.

What should ASTRO be doing? If they can't support supervision (which is beneficial to the large majority of us), what could they possibly support that people will listen to that will help the majority of RadOncs?

And why are there people here hoping for the worst possible outcome that will completely destroy the field?

I think there are are a lot of folks here who only want to talk about one thing, and that is that large hospital systems make a lot of money.

I have many posts here about this topic and the rise of corporate medicine and its impact on medicine as a whole and rad onc specifically.

but it does make these conversations difficult. see this page. Ultimately, no one has answered or really even addressed your question.

 

[communitydoc13]

Where is SCAROP? Specifically, why haven't we heard from HROP, Anderson, Mayo, City of Hope, Moffitt, Sloan, UCSF, Penn...and on and on and on, voicing their support either way?

These entities are too big to fail...on so many fronts.

They are protected regarding legal jeopardy due their size, status and legal teams. Mayo could literally say, "this has become our institutional standard after much deliberation" and it provides some level of legal protection.

They are likely tacitly for virtual supervision as it is another tool for their network expansion. They almost certainly are confident that virtual direct is here to stay. They likely have multiple service lines that are extending far into the community using virtual direct.

I actually think ASTRO is trying to protect jobs and centers. (Maybe I'm crazy).

They should be doing other things though, as mentioned above. Scope of practice needs to increase for radoncs. This means harder work but more valuable work.

There ain't no free lunch.

 

[Bequerel]

I don't understand the points people are trying to make here.

What should ASTRO be doing? If they can't support supervision (which is beneficial to the large majority of us), what could they possibly support that people will listen to that will help the majority of RadOncs?

And why are there people here hoping for the worst possible outcome that will completely destroy the field?

They should support residency contraction. Until they address that issue..I can’t take them seriously.

I think people aren’t upset that they supported supervision..I think people are upset about they way they went about it. Any good leader would have a town hall then write a letter to DC that supports the views of the majority of the group not the other way around.

 

[Ray D. Ayshun]

ACRO already has one. Liberty Partners are beasts. Look what they did for 21C.

I guess this explains why the nearby Genesis nightmares are ACRO-certified.

 

[elementaryschooleconomics]

They should be doing other things though, as mentioned above. Scope of practice needs to increase for radoncs. This means harder work but more valuable work.

There ain't no free lunch.

Bingo.

From earlier either in this thread...or another thread...who even knows, but:

Part of the reason I work more hours than what might be considered "average" for RadOnc is I immediately got involved in things other than "EBRT for Oncology".

Everyone, everywhere, should be doing the same.

Like yesterday.

 

[drowsy12]

They should support residency contraction. Until they address that issue..I can’t take them seriously.

I think people aren’t upset that they supported supervision..I think people are upset about they way they went about it. Any good leader would have a town hall then write a letter to DC that supports the views of the majority of the group not the other way around.

1) I agree they should support residency contraction. They also have no direct impact on that but could voice their opinion.
2) just because they have not done more to address supply, does NOT mean they should NOT address demand.
3) Agree that the way they did it is awful
4) LOTS of people seem very upset they they did support supervision.

 

[Mandelin Rain]

The playbook already exists.

Lobby. PR. Lobby. PR. Lobby. PR.

 

[drowsy12]

so ASTRO is meaningless, unimportant, no one cares what they have to say.

BUT I do NOT WANT THEM TO SAY ANYTHING ABOUT SUPERVISION.

but I also want them to make PR campaigns talking about how great radiation is, that will change everything.

also they released their newsletter this week talking about practical implications of benign RT, led by non-academics! but ASTRO didnt do enough to push this newsletter.


wild.

 

[CurbYourExpectations]

I agree that BO is unlikely to succeed, if something like that model becomes common place it will be "slap a sticker on your community hospital, big name academic" places.

Everyone knows residencies need to reduce spots, even the residencies.

ASTRO does appear to be working towards pushing benign and radiopharm. Supervision seems to be another way to try to protect the field as well since they "don't believe they can speak on residency positions".

 

[TheWallnerus]

ASTRO:

on the wrong side on breast IMRT, on the wrong side on protons, on the wrong side on UroRads, on the wrong side on residency expansion, on the wrong side on antitrust nonsense, wrong on its DEI obsession, wrong on ROCR, wrong on APM, on the wrong side on letting IGRT require personal supervision for so many years, and on the wrong side on supervision... again

("Wrong" is a small word that can mean a great many number of things, obv)

 

[communitydoc13]

I understand the easy logic here about "Direct Supervision means a RadOnc has to physically be present means more jobs".

That's not real. That's an illusion.

I think you are thinking of major infrastructural changes...these do not need to occur for radical demand change.

In my own practice, we will find solutions to minimize income loss. With multiple centers and an emphasis on physical presence, this sets a floor for number of docs. This floor goes away once we move to a virtual model.

This floor goes away everywhere, and corporate values will move to efficiency in terms of doctor's hours.

Forget expansion of scope of practice (what we need to do). Forget hour long consults and being the best communicator in oncology. It will be strictly technical virtual work with low level virtual clinical evaluation.

This BTW, is seemingly what lots of people want in their jobs nowadays.

I'm becoming more boomerish by the minute.

 

[elementaryschooleconomics]

I think you are thinking of major infrastructural changes...these do not need to occur for radical demand change.

In my own practice, we will find solutions to minimize income loss. With multiple centers and an emphasis on physical presence, this sets a floor for number of docs. This floor goes away once we move to a virtual model.

This floor goes away everywhere, and corporate values will move to efficiency in terms of doctor's hours.

Forget expansion of scope of practice (what we need to do). Forget hour long consults and being the best communicator in oncology. It will be strictly technical virtual work with low level virtual clinical evaluation.

This BTW, is seemingly what lots of people want in their jobs nowadays.

I'm becoming more boomerish by the minute.

Don't let me forget to return to your Bay Pilots post later on.

You're bringing in more nuance than a thread this active can handle, but it's a great example to discuss.

 

[communitydoc13]

so ASTRO is meaningless, unimportant, no one cares what they have to say.

BUT I do NOT WANT THEM TO SAY ANYTHING ABOUT SUPERVISION.

but I also want them to make PR campaigns talking about how great radiation is, that will change everything.

also they released their newsletter this week talking about practical implications of benign RT, led by non-academics! but ASTRO didnt do enough to push this newsletter.


wild.

Yeah...I'm not a member and the Proton stuff is whack...but some evidence that they are trying.

 

[NotMattSpraker]

I think there are are a lot of folks here who only want to talk about one thing, and that is that large hospital systems make a lot of money.

I have many posts here about this topic and the rise of corporate medicine and its impact on medicine as a whole and rad onc specifically.

but it does make these conversations difficult. see this page. Ultimately, no one has answered or really even addressed your question.

Hey I can answer this question really easily. ASTRO should've said nothing or just agreed with the ACR.

IF one believes that the field must respond in opposition to the ACR, they should have a protocol and process for responding to something like that with member input. They don't have that.

They clearly dont understand the current state of this policy (given their comments on the town hall) and they dont have vision on the shifting sands of healthcare.

Given all of that, they should've stayed quiet. They are failing to tell a good story about what they want.

I appreciated the town hall, but walked away more confused at the end. If I feel that way, think about how someone that isn't a radiation oncologist but instead a congressional representative's 20s year old staffer feels about their position.

This is an objective failure all around.

But at least it generated discussion, right Jeff!

 

[drowsy12]

Yeah...I'm not a member and the Proton stuff is whack...but some evidence that they are trying.

I really don’t care about Astro. I think what differentiates me is I’m not obsessed with being anti them?

Like if as ESE says, EVERYONE knows that virtual supervision will crash the demand for rad onc, then it would seem wildly idiotic for ASTRO (and ACRO who is in lockstep with them on this) to not try to stop it.

 

[elementaryschooleconomics]

so ASTRO is meaningless, unimportant, no one cares what they have to say.

BUT I do NOT WANT THEM TO SAY ANYTHING ABOUT SUPERVISION.

but I also want them to make PR campaigns talking about how great radiation is, that will change everything.

also they released their newsletter this week talking about practical implications of benign RT, led by non-academics! but ASTRO didnt do enough to push this newsletter.


wild.

ASTRO has a weight class. The butterfly effect exists.

There are effective ways for individuals and organizations to have an impact in the world.

They've been making choices like they're the AMA.

They forget RadOnc is smaller than some high schools.

 

[elementaryschooleconomics]

I really don’t care about Astro. I think what differentiates me is I’m not obsessed with being anti them?

Like if as ESE says, EVERYONE knows that virtual supervision will crash the demand for rad onc, then it would seem wildly idiotic for ASTRO (and ACRO who is in lockstep with them on this) to not try to stop it.

Whoa whoa whoa there partner, that's not what I'm saying.

I don't think demand will "crash".

I think it goes in the column of hypofrac and omission, opposite the side of residency expansion.

This is not black and white. I wish it was, it would be easier.

None of us can see the future. But Virtual Supervision is a single variable, and we can't consider it in a vacuum.

Don't forget the looming threat of AI!

 

[drowsy12]

Hey I can answer this question really easily. ASTRO should've said nothing or just agreed with the ACR.

But I don't understand why you think it's wise for ASTRO to not speak out about one of the few things they should have an opinion on. Something that it seems most people here agree will crash the field.

I've said this before and will say it again - anyone who thinks they should have done something to stop residency expansion but does not think they should have an opinion on supervision - this does not compute to me. Please explain.

I agree that sending a letter and then trying to walk it back with a town hall after it has already been sent is silly.

 

[drowsy12]

Whoa whoa whoa there partner, that's not what I'm saying.

I don't think demand will "crash".

t
well this is semantics. You said no one disagreed that it would 'undeniably change the workforce landscape incredibly'

To me this, for whoever agrees, falls into 'YOU HAVE ONE JOB' territory for ASTRO.

 

[OTN]

If this passed the way ASTRO wanted, would dermatologists with machines have to hire radoncs?

 

[Mandelin Rain]

What happens to demand for rad oncs when all those (hundreds of ?) small community linacs treating 5-12 patients close down because they are completely non-viable under direct supervision?

 

[Mandelin Rain]

If this passed the way ASTRO wanted, would dermatologists with machines have to hire radoncs?

LOL. The derms would be like, "cool story, bro."

 

[CurbYourExpectations]

What happens to demand for rad oncs when all those (hundreds of ?) small community linacs treating 5-12 patients close down because they are completely non-viable under direct supervision?

This makes no sense, why would taking some of the money from having a RadOnc on site and shifting it to the pockets of a middle man and a lower paid virtual RadOnc help in this situation?

 

[TheWallnerus]

But I don't understand why you think it's wise for ASTRO to not speak out about one of the few things they should have an opinion on. Something that it seems most people here agree will crash the field.

I've said this before and will say it again - anyone who thinks they should have done something to stop residency expansion but does not think they should have an opinion on supervision - this does not compute to me. Please explain.

I agree that sending a letter and then trying to walk it back with a town hall after it has already been sent is silly.

Because if there were only 1000 rad oncs in America virtual and general supervision flexibilities would be a brilliancy that Deep Blue would be proud of… and we all would have GREAT job security.

I’m speaking hyperbolically but you have to quit throwing good money after bad, eventually, and ASTRO is just… not helping. Paraphrasing the poet Ludacris, “Move, ASTRO, get out the way.”

 

[CurbYourExpectations]

Because if there were only 1000 rad oncs in America virtual and general supervision flexibilities would be a brilliancy that Deep Blue would be proud of… and we all would have GREAT job security.

I’m speaking hyperbolically but you have to quit throwing good money after bad, eventually, and ASTRO is just… not helping. Paraphrasing the poet Ludacris, “Move, ASTRO, get out the way.”

Okay, but who has to be the 4,000 that willingly stop being employed for this to be good for us? NOT IT

 

[Mandelin Rain]

This makes no sense, why would taking some of the money from having a RadOnc on site and shifting it to the pockets of a middle man and a lower paid virtual RadOnc help in this situation?

What are you even talking about?

I think many people are in a bubble a don't realize that currently (today, right now!) docs staff multiple sites each week to make ends meet, all without Jordan Johnson's help. If those sites needed to hire a full time doctor, they'd simply close and require no doctor. That would do nothing to increase demand for rad oncs. Quite the opposite.

 

[CurbYourExpectations]

What are you even talking about?

I think many people are in a bubble a don't realize that currently (today, right now!) docs staff multiple sites each week to make ends meet, all without Jordan Johnson's help. If those sites needed to hire a full time doctor, they'd simply close and require no doctor. That would do nothing to increase demand for rad oncs. Quite the opposite.

Couldn't those docs just have a single slightly busier site? I'm confused. Where is the job that is being created by having docs that cover multiple sites?

 

[drowsy12]

Because if there were only 1000 rad oncs in America virtual and general supervision flexibilities would be a brilliancy that Deep Blue would be proud of… and we all would have GREAT job security.

I’m speaking hyperbolically but you have to quit throwing good money after bad, eventually, and ASTRO is just… not helping. Paraphrasing the poet Ludacris, “Move, ASTRO, get out the way.”

this is at least a reasonable reply. I see where you are coming from.

It just means we are in a world of hurt for a while, before somehow magically we end up at 1000 Rad Oncs again?

you're almost done soon I imagine. it's the rest of us that will be caught holding the bag.

 

[Mandelin Rain]

Couldn't those docs, just have a single slightly busier site? I'm confused. Where is the job that is being created by having docs that cover multiple sites?

Doubtful. Those patients would either; not receive care or go to regional academic medical complex 2 hours away where they'd be divvyed up among the 12 employed docs already hired.

 

[TheWallnerus]

this is at least a reasonable reply. I see where you are coming from.

It just means we are in a world of hurt for a while, before somehow magically we end up at 1000 Rad Oncs again?

you're almost done soon I imagine. it's the rest of us that will be caught holding the bag.

This is where the serenity prayer, changing things you can change, and the second law of thermodynamics comes in to play.

 

[MidwestRadOnc]

Whoa whoa whoa there partner, that's not what I'm saying.

I don't think demand will "crash".

I think it goes in the column of hypofrac and omission, opposite the side of residency expansion.

This is not black and white. I wish it was, it would be easier.

None of us can see the future. But Virtual Supervision is a single variable, and we can't consider it in a vacuum.

Don't forget the looming threat of AI!

Demand may not crash, but cuts are inevitable. There will come a point when the government is forced to cut spending, and medicare is a very big target. This point seems to be rapidly accelerating. This supervision stuff is trying to put a finger in the dike, but there will be bigger problems to deal with when that time comes.

That said, watching the recording, Michalski is basically telling me that the way I practice is wrong. Who the hell is he to make that call for the rest of the specialty or determine what schedule is appropriate for my rural clinic he knows nothing about? The level of arrogance is astounding and reflected in his tone of voice and general demeanor.

 

[TheWallnerus]

Demand may not crash, but cuts are inevitable. There will come a point when the government is forced to cut spending, and medicare is a very big target. This point seems to be rapidly accelerating. This supervision stuff is trying to put a finger in the dike, but there will be bigger problems to deal with when that time comes.

That said, watching the recording, Michalski is basically telling me that the way I practice is wrong. Who the hell is he to make that call for the rest of the specialty or determine what schedule is appropriate for my rural clinic he knows nothing about? The level of arrogance is astounding and reflected in his tone of voice and general demeanor.

I think there is certainly some reasonableness to thinking the government wants to cut spending on healthcare. But…

Next year the federal government will pay private insurance companies a record breaking $500 billion to move Medicare patients to Medicare Advantage. And there is no clear savings to the government for doing this (and it’s accelerating). UnitedHealth is the largest employer of physicians in the US, and their biggest profit center is Medicare Advantage (ie, they profit from the government and our taxes… what a country!).

 

[MidwestRadOnc]

What happens to demand for rad oncs when all those (hundreds of ?) small community linacs treating 5-12 patients close down because they are completely non-viable under direct supervision?

I will tell you exactly what happens. At least half of those patients would not get radiation treatment. These people will not or cannot travel to cities for radiation.

Part-time radiation oncology is necessary for many of these sites to remain viable, let alone ensure a competent rad onc is managing the care.
The ivory tower is both out of touch and doesn't care. You think they want to drive out and cover these sites themselves? Oh they'll do that a few weeks a year once they are retired and bored, sure. That's the wrong way to provide care in rural America.

The CAH exemption is not good enough. Most CAH cannot support radiation. They can barely support an ED.

 

[drowsy12]

carveouts already exist for many of these situations, and for the ones that don't fit, they should be expanded.

I think what some of us think would be a good idea are some sort of guardrails that would prevent a significant impact to the demand for Rad Oncs.

If we really do think it is undeniable that a major impact is coming if virtual supervision is taken to the greatest impact, you would have to be either:

1) retiring
2) a dummy
3) callous

to not care.

 

[TheWallnerus]

carveouts already exist for many of these situations,

Explain

 

[drowsy12]

Explain

I will admit I don't know the exact rules or terminology of this, but I have multiple friends that work in groups that are multi-site multi hospital, and one of the sites is classified as rural enough that a rad onc doc is only needed one day a week, and this has been ongoing for at least a decade. What is this called?

 

[MidwestRadOnc]

carveouts already exist for many of these situations, and for the ones that don't fit, they should be expanded.

I think what some of us think would be a good idea are some sort of guardrails that would prevent a significant impact to the demand for Rad Oncs.

Metropolitan statistical area - Wikipedia

en.wikipedia.org

There are 387 metropolitan statistical areas in the US. My center is not in any of them, or even a micropolitan statistical area.

Even in the actual MSAs, there are very clearly some centers that would be very "rural."

Ok, how about the top 50 MSAs require direct and everyone else is general or virtual? For the explicit purposes of protecting the specialty, not some specious safety or quality of care argument, since this is where the most of the rad oncs are anyway. Ok, fine. At least that's a non-insane and honest start. But who sets the line?

 

[Mandelin Rain]

I will admit I don't know the exact rules or terminology of this, but I have multiple friends that work in groups that are multi-site multi hospital, and one of the sites is classified as rural enough that a rad onc doc is only needed one day a week, and this has been ongoing for at least a decade. What is this called?

Good health care.

 

[drowsy12]

Good health care.

sure. not germane but sure.

can you clarify your position. you don't think astro should care about supervision as there will be no impact to the labor force?

 

[Bequerel]

I will admit I don't know the exact rules or terminology of this, but I have multiple friends that work in groups that are multi-site multi hospital, and one of the sites is classified as rural enough that a rad onc doc is only needed one day a week, and this has been ongoing for at least a decade. What is this called?

It sounds like it should be called a system that has been working for at least a decade with no problems so quit trying to fix something that ain’t broke. Instead, go fix one of the million things that are already broken.

 

[drowsy12]

It sounds like it should be called a system that has been working for at least a decade with no problems so quit trying to fix something that ain’t broke. Instead, go fix one of the million things that are already broken.

I don't think you know what you are saying.